Single-port versus multi-port totally extraperitoneal (TEP) inguinal hernia repair: A meta-analysis of randomized controlled trials.

BACKGROUND: The value of single-port totally extraperitoneal inguinal hernia repair (STEP) when compared to the conventional multi-port approach (TEP) is still a matter of controversy. We conducted a meta-analysis of randomized controlled trials comparing the feasibility and safety of the above-mentioned techniques. METHODS: A systematic literature search for randomized controlled trials (RCTs) comparing the outcome STEP and TEP in patients with inguinal hernia was conducted. Data regarding postoperative outcomes were extracted and compared by meta-analysis. The Odds Ratio and Standardized Mean Differences with 95% Confidence Intervals (CI) were calculated. RESULTS: Six RCTs were identified, involving a total of 636 cases (STEP: n = 328, TEP: n = 308). There was a statistically significant difference noted between the 2 groups regarding return to everyday activities favoring the STEP group (SMD = -0.23; 95% CI [-0.41, -0.06]; P = .01; 4 studies; I2 = 9). For the remaining primary and secondary endpoints, intra- and postoperative morbidity, conversion rate, peritoneal tears, major intraoperative bleeding, postoperative haematoseroma, operative time, postoperative pain, chronic pain, cosmetic satisfaction, hernia recurrence and in-hospital length of stay no statistically significant difference was noted between the 2 study groups. CONCLUSIONS: Current evidence suggests that patients who underwent STEP had similar outcomes to the traditional TEP technique with the exception of time to return to everyday activities, which was reported to be shorter in the STEP group.

Prognostic Performance of Alternative Lymph Node Classification Systems for Patients with Medullary Thyroid Cancer: A Single Center Cohort Study.

BACKGROUND: Lymph node ratio (LNR) and the log odds of positive lymph nodes (LODDS) have been proposed as alternative lymph node (LN) classification schemes. Various cut-off values have been defined for each system, with the question of the most appropriate for patients with medullary thyroid cancer (MTC) still remaining open. We aimed to retrospectively compare the predictive impact of different LN classification systems and to define the most appropriate set of cut-off values regarding accurate evaluation of overall survival (OS) in patients with MTC. METHODS: 182 patients with MTC who were operated on between 1985 and 2018 were extracted from our medical database. Cox proportional hazards regression models and C-statistics were performed to assess the discriminative power of 28 LNR and 28 LODDS classifications and compare them with the N category according to the 8th edition of the AJCC/UICC TNM classification in terms of discriminative power. Regression models were adjusted for age, sex, T category, focality, and genetic predisposition. RESULTS: High LNR and LODDS are associated with advanced T categories, distant metastasis, sporadic disease, and male gender. In addition, among 56 alternative LN classifications, only one LNR and one LODDS classification were independently associated with OS, regardless of the presence of metastatic disease. The C-statistic demonstrated comparable results for all classification systems showing no clear superiority over the N category. CONCLUSION: Two distinct alternative LN classification systems demonstrated a better prognostic performance in MTC patients than the N category. However, larger scale studies are needed to further verify our findings.

Effect of Previous Lower Abdominal Surgery on Outcomes Following Totally Extraperitoneal (TEP) Inguinal Hernia Repair.

BACKGROUND: Previous lower abdominal surgery is generally considered as a relative contraindication for laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. Our objective was to investigate the feasibility and safety of TEP repair in patients with a history of lower abdominal surgery. MATERIALS AND METHODS: A retrospective analysis of 301 patients with inguinal hernia who underwent elective laparoscopic TEP repair between August 2010 and August 2014 was conducted. One-hundred five patients (34.9%) had previously undergone lower abdominal surgery. The main outcome measures included intraoperative and postoperative morbidity and mortality. Secondary outcomes were immediate postoperative pain, presence of chronic pain at follow-up, and hernia recurrence. RESULTS: Patient demographics and clinical variables were balanced between the 2 groups, with the exception of age. Intraoperative morbidity was similar between cases without previous lower abdominal surgery (nPS) and cases with history of lower abdominal surgery (PS) [nPS vs. PS: 0.5% (n=1) vs. 2.8% (n=3), P=0.09]. Overall 30-day morbidity was found to be significantly higher in the PS patient group [nPS vs. PS: 1.5% (n=3) vs. 6.6% (n=7), P=0.018]. Mortality was nil. There were no differences noted between the 2 groups with respect to early postoperative pain and chronic inguinal pain. Complete follow-up information was available for 149 of 301 patients (follow-up rate of 49.5%, range: 3 to 48 mo) with a mean follow-up time of 20.38 months (SD=7.7). There was no statistically significant difference noted in the recurrence rate between the 2 patient groups at follow-up [nPS vs. PS: 3.2% (n=3) vs. 1.8% (n=1), P=0.6]. CONCLUSIONS: The present work demonstrates higher incidence of postoperative scrotal hematoma after TEP repair in patients with history of previous lower abdominal surgery. All remaining outcomes of interest were found to be similar between the 2 patient groups. Further trials will be needed to verify our findings.